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Home My WebLink About3488-zFORM NO. 4 TOWN OF SOUTYIOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. F:.EI~TIFIE:ATE FIF OI-:.E~UPANE:Y No. 2~ 2894 Date ...... THIS CERTIFIES that the building located at Laugh:lng. Water. ......... Stree~ Map No...~ Block No .... ~ ...... Lot No...~ ........ ~q$~..N, ~.,... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... ~Y. ~ ......... , 19 dated ..... ~a~ .~ ........... , 19.67., was issued, and conforms to all of the require- ments of the applic'able provisions of the law. The occupancy for which this certificate is issued is .... ~cce~o~y. The certificate is issued ~o (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........ N~ ....................... Building Insl~ector FORM NO." TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CFHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~1'? 3488 Z Dote .............................. ..)~..Z ....... . .2..~. ....... , 19..~... Permission is hereby granted to: C~'~ Boe~.gess~ ............... ................................................ to E~C~ ~t~ ...~.t~.~n new tool shed .~acceaso...~. Bldg) ...... southoldt N.Y. pursuon,t to opplication dated ................................ ~ ............ ~..~....., 19..0..~..., and approved by the Building Inspector. Building Inspector ( T~WN OF SOUTHOLD BUll. DING DEPARTN~E~IT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ..... Permit No ............................. (Building Ir~pector) Application No.....~....~./..~.,~.... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appllcation. c. The work covered by this application may not be commenced before issucnce of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. The applicant agrees to comply with all applicable lows, APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ordinances, building code and regulations. Stote whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~.~....?..'......~...~..~..~~..~... .......................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Locotion of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number .~..~,/.z~?...~. ' .....~../.~L~:~ ......................................... ~ .......................... ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ................................................................................................................................... Intended use and occupancy ........................................................................................... 3. Nature of work (check which applicable): New Building l// Addition Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) .......................... ~. ........ .~ .... 4. Estimated Cost .~.~'.~.~.. ................ Fee ...................................................................... ~... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ if garage, number of oars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... ~/..~'.../. ....................... I Rear ......... /..~.. ............ Depth .....~.... ............. Height .~...! .............. Number of Stories ../. ................................................................................................................. 9. Size of lot: Front ...... I..1...~....! ......... Rear ....... .~...(~ ................... Depth ......... J..[.~. .............. · ,..L 10. Date of Purchase ....................... Name Farmer Owner ...... .C...._ 1 I. Zone or use district m which premises are situated ..................................................................................................... 12 ................................ Does proposed construction violate any~ -z°ning law, ordinance or regulotionP .............................. 13. Name of Owner of premise~...~.'.,.~,,Address .~.~,~¢,1~.,,~, ................. Phone No, Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................................ (Nam. e of i~. ivid,ua_l ~i~gn. ing application) above named. He is the ..~ ................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this · .:.. )~. ...................................... Notary Public, . ........................................................... County (Signai~[Jre of applicant)